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How to improve the organ preservation maneuvers after unsuccessful CPR in non heart beating donors?
Abstracts / Resuscitation 85S (2014) S15–S121
AP231
AP232
Validating a pragmatic definition of shock in adult patients presenting to the emergency department
How to improve the organ preservation maneuvers after unsuccessful CPR in non heart beating donors?
Timothy Rainer 1,∗ , Yan-ling Li 2 , Cangel Chan 1 , Nandini Agarwal 1 , Kin-keung Sin 3 , Stewart Chan 1 , Pei-yi Lin 2 , Xiao-hui Chen 2 , Brendan Smith 4 , Gavin Joynt 1 , Colin Graham 1
María Bringas Bollada 1,∗ , Nieves de Lucas García 2 , Francisco del Rio Gallegos 1 , Eduardo Morales Sorribas 3 , Ana Soria García 1 , Isabel Perez Flores 1 , Manuel Gonzalez Romero 1 , Marta Cubells Romeral 4
1
Chinese University of Hong Kong, Shatin, NT, Hong Kong 2 Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China 3 Hong Kong University of Science and Technology, Hong Kong 4 Charles Sturt University, Bathurst, New South Wales, Australia Objective: The importance of the early recognition of shock in patients presenting to emergency departments is well recognized but at present there is no agreed practical definition for undifferentiated shock. The main aim of this study was to validate an ‘a priori’ clinical definition of shock against 28-day mortality. Design, setting and subjects: This prospective, observational, cross-sectional, single-centre study was conducted in Hong Kong, China. Data was collected between 1 July 2012 and 31 January 2013. An ‘a priori’ definition of shock was designed, whereby patients admitted to the resuscitation room or high dependency area of the Emergency Department were divided into one of three groups – no shock, possible shock and shock. The primary outcome was 28day mortality. Secondary outcomes were in-hospital mortality or admission to the intensive or coronary care unit (ICCU). Measurements and main results: One hundred and eleven patients (mean age 67.2 ± 17.1 years; male = 69 (62%)) were recruited of which 22 were classified as no shock, 54 as possible shock, and 35 as shock. Systolic blood pressure (SBP), mean arterial pressure (MAP), lactate and base deficit correlated well with shock classifications (P < 0.05). Patients who had ≥3 positively defined shock variables had a 100% poor composite outcome rate (5/5). Patients with two shock variables had a 66.7% (4/6) poor composite outcome rate. Conclusions: A simple, practical definition of undifferentiated shock has been proposed and validated in a group of patients presenting to an emergency department in Hong Kong. This definition needs further validation in a larger population and other settings. http://dx.doi.org/10.1016/j.resuscitation.2014.03.280
S113
1
Hospital Clinico San Carlos, Madrid, Spain Samur-Proteccion Civil, Madrid, Spain 3 Hospital de Torrejon, Torrejon de Ardoz, Madrid, Spain 4 Hospital Rey Juan Carlos, Mostoles, Madrid, Spain 2
Introduction: Our hospital has settled from 1989 an specific protocol to obtain donor from people who die in the street or at home from sudden or unexpected death. Even this program has been improving, we’ve observed a reduction in the amount of transplants although the number of donors remains stable. New variables need to be studied. Material and methods: After 30 min of unsuccessful CPR maneuvers death is declared through cardiovascular criteria. The only preservation method until ECMO is cardiac massage and mechanical ventilation. In addition to general procedure we analyze: age, kind of cardiocompression, personal antecedents and warm and cold ischemia times Results: 46 donors were included during 2013. 54 kidneys were desestimated for transplant. We analyze quantitative variables through student. We found association between age and discharged kidneys (51 years for discharged kidney p = 0.004; IC 95% 3, 0–15.1) and for warm ischemia time (116 min for discharged kidneys, p = 0.03; IC 95% 0.5–17.4). No association was found between desestimation, weigth, tall, abdominal and thoracic perimeters. Among real donor 57 kidneys were transplanted. Five were explanted (4 because ischemia reperfusion injury, 1 surgical injury). The rest remains normofunctional and free of complications. Discussion: Although NHBD is an excellent way to expand the donors pool, the trend to reduce the number of organs transplanted has made us to consider the necessity to optimize the preservation maneuvers optimizing the CPR as preservation method. Conclusions: (1) NHBD program constitutes 40% of the total donor amount of Madrid (34.5 d.p.m.p). (2) It is important to establish new variables to improve organ preservation: mechanical versus manual cardiocompression, amount of fluids, pH, capnography, LDH, number of desfibrilation, BMI, first detected cardiac rhythm. (3) The effectiveness of CPR is the cornerstone of NHBD program. http://dx.doi.org/10.1016/j.resuscitation.2014.03.281
AP231
AP232
Validating a pragmatic definition of shock in adult patients presenting to the emergency department
How to improve the organ preservation maneuvers after unsuccessful CPR in non heart beating donors?
Timothy Rainer 1,∗ , Yan-ling Li 2 , Cangel Chan 1 , Nandini Agarwal 1 , Kin-keung Sin 3 , Stewart Chan 1 , Pei-yi Lin 2 , Xiao-hui Chen 2 , Brendan Smith 4 , Gavin Joynt 1 , Colin Graham 1
María Bringas Bollada 1,∗ , Nieves de Lucas García 2 , Francisco del Rio Gallegos 1 , Eduardo Morales Sorribas 3 , Ana Soria García 1 , Isabel Perez Flores 1 , Manuel Gonzalez Romero 1 , Marta Cubells Romeral 4
1
Chinese University of Hong Kong, Shatin, NT, Hong Kong 2 Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China 3 Hong Kong University of Science and Technology, Hong Kong 4 Charles Sturt University, Bathurst, New South Wales, Australia Objective: The importance of the early recognition of shock in patients presenting to emergency departments is well recognized but at present there is no agreed practical definition for undifferentiated shock. The main aim of this study was to validate an ‘a priori’ clinical definition of shock against 28-day mortality. Design, setting and subjects: This prospective, observational, cross-sectional, single-centre study was conducted in Hong Kong, China. Data was collected between 1 July 2012 and 31 January 2013. An ‘a priori’ definition of shock was designed, whereby patients admitted to the resuscitation room or high dependency area of the Emergency Department were divided into one of three groups – no shock, possible shock and shock. The primary outcome was 28day mortality. Secondary outcomes were in-hospital mortality or admission to the intensive or coronary care unit (ICCU). Measurements and main results: One hundred and eleven patients (mean age 67.2 ± 17.1 years; male = 69 (62%)) were recruited of which 22 were classified as no shock, 54 as possible shock, and 35 as shock. Systolic blood pressure (SBP), mean arterial pressure (MAP), lactate and base deficit correlated well with shock classifications (P < 0.05). Patients who had ≥3 positively defined shock variables had a 100% poor composite outcome rate (5/5). Patients with two shock variables had a 66.7% (4/6) poor composite outcome rate. Conclusions: A simple, practical definition of undifferentiated shock has been proposed and validated in a group of patients presenting to an emergency department in Hong Kong. This definition needs further validation in a larger population and other settings. http://dx.doi.org/10.1016/j.resuscitation.2014.03.280
S113
1
Hospital Clinico San Carlos, Madrid, Spain Samur-Proteccion Civil, Madrid, Spain 3 Hospital de Torrejon, Torrejon de Ardoz, Madrid, Spain 4 Hospital Rey Juan Carlos, Mostoles, Madrid, Spain 2
Introduction: Our hospital has settled from 1989 an specific protocol to obtain donor from people who die in the street or at home from sudden or unexpected death. Even this program has been improving, we’ve observed a reduction in the amount of transplants although the number of donors remains stable. New variables need to be studied. Material and methods: After 30 min of unsuccessful CPR maneuvers death is declared through cardiovascular criteria. The only preservation method until ECMO is cardiac massage and mechanical ventilation. In addition to general procedure we analyze: age, kind of cardiocompression, personal antecedents and warm and cold ischemia times Results: 46 donors were included during 2013. 54 kidneys were desestimated for transplant. We analyze quantitative variables through student. We found association between age and discharged kidneys (51 years for discharged kidney p = 0.004; IC 95% 3, 0–15.1) and for warm ischemia time (116 min for discharged kidneys, p = 0.03; IC 95% 0.5–17.4). No association was found between desestimation, weigth, tall, abdominal and thoracic perimeters. Among real donor 57 kidneys were transplanted. Five were explanted (4 because ischemia reperfusion injury, 1 surgical injury). The rest remains normofunctional and free of complications. Discussion: Although NHBD is an excellent way to expand the donors pool, the trend to reduce the number of organs transplanted has made us to consider the necessity to optimize the preservation maneuvers optimizing the CPR as preservation method. Conclusions: (1) NHBD program constitutes 40% of the total donor amount of Madrid (34.5 d.p.m.p). (2) It is important to establish new variables to improve organ preservation: mechanical versus manual cardiocompression, amount of fluids, pH, capnography, LDH, number of desfibrilation, BMI, first detected cardiac rhythm. (3) The effectiveness of CPR is the cornerstone of NHBD program. http://dx.doi.org/10.1016/j.resuscitation.2014.03.281